Central Forms of Nystagmus

Characteristics and Clinical Implications

Gaze-evoked nystagmus (GEN) is definitively a central form of nystagmus, typically indicating pathology in the brainstem or cerebellum, according to the American Academy of Otolaryngology-Head and Neck Surgery 1
Central nystagmus (including GEN) typically does not fatigue and is not easily suppressed by visual fixation, unlike peripheral nystagmus, as noted by the American Academy of Otolaryngology-Head and Neck Surgery 2
The American Academy of Otolaryngology-Head and Neck Surgery identifies GEN as a central finding that helps distinguish central from peripheral causes of vertigo 3

When GEN is identified, neuroimaging (preferably MRI) is indicated to evaluate for structural lesions of the brainstem or cerebellum, as recommended by the American College of Radiology 4
A thorough neuro-ophthalmological examination should be performed to identify other associated central ocular motor abnormalities 6

GEN must be distinguished from peripheral vestibular nystagmus, which typically has a torsional component and is suppressed by visual fixation, according to the American Academy of Otolaryngology-Head and Neck Surgery 3
The presence of GEN should raise suspicion for serious central pathology, particularly when accompanied by other neurological signs, as noted by the American Academy of Otolaryngology-Head and Neck Surgery 1